- Email: [email protected]
Dame Cicely Mary Strode Saunders
St Christopher’s Hospice
Obituary
Dame Cicely Mary Strode Saunders Founder of St Christopher’s Hospice, Sydenham, London, UK, and of the modern hospice movement. Born on June 22, 1918, in London, UK, she died of breast cancer at St Christopher’s Hospice, London, on July 14, 2005, aged 87 years. In 1947, while working as a lady almoner at Archway Hospital, London, UK, Cicely Saunders took care of a dying patient, David Tasma, who was a survivor of the Warsaw ghetto. She and Tasma began discussing how the care of those at the end of their lives might be improved, according to David Clark, a historian at Lancaster University, UK, who worked with Saunders to document the history of hospice care. Eventually, Saunders, who had originally trained as a nurse, would go on to medical school after a thoracic surgeon she was working for told her “go and read medicine, it’s the doctors who desert the dying, and there’s so much more to be learned about pain”, she said in a 2003 interview. After graduating in 1958, Saunders spent several years doing research and laying the groundwork for modern hospice care. When she began her research, “physicians thought that morphine was inevitably addictive and that it was not useful by mouth”, Nigel Sykes, now medical director of St Christopher’s Hospice, told The Lancet. “The patient had to ‘earn their morphine’. That meant that a lot of people were suffering a lot of pain. What she showed was that if you titrated it just against the pain response that it worked by mouth, and did not cause addiction, and also did not obtund people. That produced a huge change over time in the approach to pain management.” But “the advances in pharmacology and the new technologies are not the whole 628
story”, Saunders wrote in the BMJ in 1996; she valued listening to patients perhaps above all else. “What was astonishing about her achievement in the late 1950s was two things: she was trying to focus attention on care of dying, a field that no one cared about, and she was doing it as a woman in a heavily male-dominated profession”, Clark told The Lancet. Things came together when she opened St Christopher’s in Sydenham, London, in 1967. What made St Christopher’s unique was that it combined clinical care, research—the work of Robert Twycross is especially well known—and education. “Over the years St Christopher’s has taught about 50 000 health-care professionals around the world, and there is now hospice care in 120 countries”, Sykes told The Lancet. “She wasn’t just about changing things in London. She wanted to change things for the whole country and for the whole world.” “She certainly moved physicians forward in understanding that death is not a failure”, said Val Halamandaris, president of the US National Association for Home Care and Hospice. Within 20 years of St Christopher’s founding, palliative care was recognised as its own specialty in the UK. Saunders had no illusions that a single hospice in London would be able to serve every patient who needed its services, and she knew that end-of-life care should take place “as much as possible at home, and when that was impossible, in a controlled setting”, Halamandaris said. St Christopher’s established a home care unit in 1969 that became a model for others. She would remain as medical director of the hospice until 1985. Saunders no longer did routine daily clinical work when Sykes arrived at St Christopher’s as a registrar 20 years ago, but she used to take turns in the weekend rota. “When you came back on Monday morning it could be a bit disconcerting”, Sykes said. “Your patients would say to you, I met this wonderful doctor. She came and spent time with me.” Saunders showed that health providers could discuss dying with patients. “One was aware right from that point that although she was no longer fully engaged in clinical work, she had not lost her touch”, Sykes said. Having trained as a nurse, almoner, and doctor, “she was a complete multiprofessional team in one person”, he said. Religion was extremely important to Saunders, who made a daily practice of spiritual reading, contemplation, and prayer. “I think she found in that something very, very important that maintained her through a lot of difficult times both personally and professionally”, Clark said. In 1980, Queen Elizabeth II bestowed upon Saunders the title of Dame, one of many honours she was awarded throughout her life. Saunders is survived by two brothers, John Saunders and Christopher Saunders. Her husband of 15 years, the Polish artist Marian Bohusz-Sysko, died in 1995.
Ivan Oransky [email protected]
www.thelancet.com Vol 366 August 20, 2005
Obituary
Dame Cicely Mary Strode Saunders Founder of St Christopher’s Hospice, Sydenham, London, UK, and of the modern hospice movement. Born on June 22, 1918, in London, UK, she died of breast cancer at St Christopher’s Hospice, London, on July 14, 2005, aged 87 years. In 1947, while working as a lady almoner at Archway Hospital, London, UK, Cicely Saunders took care of a dying patient, David Tasma, who was a survivor of the Warsaw ghetto. She and Tasma began discussing how the care of those at the end of their lives might be improved, according to David Clark, a historian at Lancaster University, UK, who worked with Saunders to document the history of hospice care. Eventually, Saunders, who had originally trained as a nurse, would go on to medical school after a thoracic surgeon she was working for told her “go and read medicine, it’s the doctors who desert the dying, and there’s so much more to be learned about pain”, she said in a 2003 interview. After graduating in 1958, Saunders spent several years doing research and laying the groundwork for modern hospice care. When she began her research, “physicians thought that morphine was inevitably addictive and that it was not useful by mouth”, Nigel Sykes, now medical director of St Christopher’s Hospice, told The Lancet. “The patient had to ‘earn their morphine’. That meant that a lot of people were suffering a lot of pain. What she showed was that if you titrated it just against the pain response that it worked by mouth, and did not cause addiction, and also did not obtund people. That produced a huge change over time in the approach to pain management.” But “the advances in pharmacology and the new technologies are not the whole 628
story”, Saunders wrote in the BMJ in 1996; she valued listening to patients perhaps above all else. “What was astonishing about her achievement in the late 1950s was two things: she was trying to focus attention on care of dying, a field that no one cared about, and she was doing it as a woman in a heavily male-dominated profession”, Clark told The Lancet. Things came together when she opened St Christopher’s in Sydenham, London, in 1967. What made St Christopher’s unique was that it combined clinical care, research—the work of Robert Twycross is especially well known—and education. “Over the years St Christopher’s has taught about 50 000 health-care professionals around the world, and there is now hospice care in 120 countries”, Sykes told The Lancet. “She wasn’t just about changing things in London. She wanted to change things for the whole country and for the whole world.” “She certainly moved physicians forward in understanding that death is not a failure”, said Val Halamandaris, president of the US National Association for Home Care and Hospice. Within 20 years of St Christopher’s founding, palliative care was recognised as its own specialty in the UK. Saunders had no illusions that a single hospice in London would be able to serve every patient who needed its services, and she knew that end-of-life care should take place “as much as possible at home, and when that was impossible, in a controlled setting”, Halamandaris said. St Christopher’s established a home care unit in 1969 that became a model for others. She would remain as medical director of the hospice until 1985. Saunders no longer did routine daily clinical work when Sykes arrived at St Christopher’s as a registrar 20 years ago, but she used to take turns in the weekend rota. “When you came back on Monday morning it could be a bit disconcerting”, Sykes said. “Your patients would say to you, I met this wonderful doctor. She came and spent time with me.” Saunders showed that health providers could discuss dying with patients. “One was aware right from that point that although she was no longer fully engaged in clinical work, she had not lost her touch”, Sykes said. Having trained as a nurse, almoner, and doctor, “she was a complete multiprofessional team in one person”, he said. Religion was extremely important to Saunders, who made a daily practice of spiritual reading, contemplation, and prayer. “I think she found in that something very, very important that maintained her through a lot of difficult times both personally and professionally”, Clark said. In 1980, Queen Elizabeth II bestowed upon Saunders the title of Dame, one of many honours she was awarded throughout her life. Saunders is survived by two brothers, John Saunders and Christopher Saunders. Her husband of 15 years, the Polish artist Marian Bohusz-Sysko, died in 1995.
Ivan Oransky [email protected]
www.thelancet.com Vol 366 August 20, 2005